Bites and maulings by dogs, sometimes fatal, are a worldwide problem and particularly affect children. Every year 250 000 people who have been bitten by dogs attend minor injuries and emergency units in the United Kingdom,1 and some of them are admitted to hospital for surgical debridement or intravenous antibiotics.

Increasingly, dog bites are the subject of litigation because bite wounds are still being sutured when they should be left open and because of incorrect antimicrobial prophylaxis.

The “hole and tear” effect—whereby canine teeth anchor the person while other teeth bite, shear, and tear the tissues—results in stretch lacerations, easily piercing immature cranial bones. The biting force of canine jaws varies with the breed, from 310 kPa to nearly 31 790 kPa in specially trained attack dogs.^{w1 w2} Large wounds, significant devitalisation, and high mortality can result, with the highest mortality in neonates (six times that in toddlers), who are usually bitten by household pets.23

This review is aimed at clinicians who deal with dog bites. The basic principles of wound management and indications for use of antimicrobials and rabies prophylaxis apply to clinicians in all countries, but the primary focus of this article will be the UK.

Overall, the clinical approach …